As an-editor-in chief Greenfield wrote open editorials (opinion pieces) for Surgery News. He found a very suitable theme for the February issue: Valentine’s day.

Valentine’s Day is about love, and the editorial was about romantic gut feeling possibly having a physiological basis. In other words, the world of sexual chemical signals that give you butterflies-feelings. The editorial jumps from mating preferences of fruit flies, stressed female rotifers turning into males and synchronization of menstrual cycles of women who live together, to a study suggesting that “exposure” to semen makes female college students less depressed. All 4 topics are based on scientific research, published in peer review papers.

Valentines Day asks for giving this “scientific” story a twist, so he concludes the editorial as follows:

“So there’s a deeper bond between men and women than St. Valentine would have suspected, and now we know there’s a better gift for that day than chocolates.”

Now, everybody knows that that conclusion ain’t supported by the data.
This would have required at least a double-blind randomized trial, comparing the mood-enhancing effects of chocolate compared to ……. (yikes!).

Just joking, of course…., similar as dear Lazar was trying to be funny….

No, the editorial wasn’t particularly funny.

And somehow it isn’t pleasant to think of a man’s love fluid wrapped in a ribbon and a box with hearts, while you expect some chocolates. Furthermore it suggests that sperm is something a man just gives/donates/injects, not a resultant of mutual love.

Greenfield’s apologies weren’t enough, women surgeons brought the issue to the Board of Regents, who asked him to resign, which he eventually did.

A few weeks later he wrote a resentful letter. This is not a smart thing to do, but is understandable for several reasons. First, he didn’t he mean to be offensive and made his apologies. Second, he has an exemplary career as a longtime mentor and advocate of women in surgery. Third, true reason for his resign wasn’t the implicit plead for unprotected sex, but rather that the editorial reflected “a macho culture in surgery that needed to change.”Fourth, his life is ruined over something trivial.

(…) Frankly, I don’t see the problem. I find it rather funny and harmless. Perhaps because I’m from Europe, where most people have a more relaxed attitude towards sex. Something like ‘nipplegate’ could never happen here (a nipple on tv, so what). (…)I have been wondering for years why so many Americans seem to think violence is fine and sex is scary.

Not only female surgeons object to the editorial. Well-known male (US) surgeons “fillet” the editorial at their blogs: Jeffrey Parks at Buckeye Surgeon ( 1 and 2), Orac Knows at Respectful Insolence (1 and 2) and Skeptical Scalpel (the latter quite mildly).

Jeffrey and Orac do not only think the man is humorless and a sexist, but also that the science behind the mood-enhancing aspects of semen is crap.

Although Jeffrey only regards “The “science” a little suspect as per Orac.”…. Because of course: “Orac knows.”

Orac exaggerates what Greenfield has said in the “breathtakingly inappropriate and embarrassing article for Surgery News”, as he calls it. [1]: “Mood-enhancing effects of semen” becomes in Orac’s words “the cure for female depression“ and “a woman needs a man to inject his seed into her in order to be truly happy“.
Of course, it is not fair to twist words this way.

If Greenfield used Scientific American as a source he should have read it all to the end, where the author states: “I bid adieu, please accept, in all sincerity, my humblest apologies for what is likely to be a flood of bad, off-color jokes—men saying, “I’m not a medical doctor, but my testicles are licensed pharmaceutical suppliers” and so on—tracing its origins back to this innocent little article. Ladies, forgive me for what I have done.”

His words were not sharp. Each statement is softened somewhat with the words “Likely” and “Unlikely”. Furthermore the title says ” New Hires“. More importantly he introduces the slide by saying. “We did a lot of new hiring the last years. We are unlikely in the future to hire new librarians. We probably hit our max” …. (emphasis mine) Etcetera.

Have all those furious librarians bothered to listen to the entire speech or do they rely on one annoyed librarian as their source?

As a matter of fact I find the annoying annoyed librarian far more offensive towards library PhD’s than Jeff is towards traditional librarians. He/she says for instance:

So PhD-librarians are always inferior, unmotivated librarians and failed scientists? Well let me tell you: working for many years as a post-doc, I switched to a library job, for positive reasons. I was looking for a permanent job too, but as stated elsewhere I find the librarian job far more rewarding. I love it and I think I am good at it (just like my non-PhD colleagues by the way).

I have listened to the entire presentation (available here). Not with great attention though, because – in spite of the controversial topic- the monotonous soft voice and the endless lists of bullets didn’t engage me. In fact I really missed a “real conceptual view”. Somewhere (slide 40-42) Jeff says:

“We didn’t spend a great deal of time talking about vision and mission, we just want to get it done. We didn’t want to over-analyze it. We want to just pick a direction and go for it. We felt that the survival of the academic library was dependent upon our ability to start acting upon something. So we just started saying “Yes, thank you”. If the dean (…) asked if we were willing to do X, Y and Z, our response was just “Yes thank you”, whether or not we actually thought it would fit into the traditional library definition.”
….”We spend a lot of our time and effort in integrating technologies throughout the library, whatever that might be, whether it was for a Facebook-page, we experimented with Second Life a little bit… we did a lot with You Tube, we still are…..” (emphasis mine)

That is not a well underpinned vision. It doesn’t sound convincing either. It just sounds as if fate decided the direction of the McMaster University Library.

What else did Jeff say?

He started: “Do not fear to be eccentric, for every opinion accepted was once eccentric.” That was a warning.

Next he explained why transformation of the (his) library was necessary: the (McMaster) library was in state of decline, it was disconnected from the campus and there was/is a funding challenge. The major challenge is the perception of the library. (Well, that won’t be unique).

Innovations were:

Add new blood.

1/3 less staff (for budgetary reasons, mostly through retirement)

Eliminate cataloging (which in Jeff’s words does NOT mean elimination of librarians but reallocation staffing to public services, with -as a result- at least one librarian blossoming in new function).

Eliminate reference and circulation desk

Create new media center, meant to engage students with gaming suites

Reallocate budget, buying games

Less face to face services

Emphasis on Special Collections (like 20 years of radio/advertising). Therefore likely to hire more IT and do more research.

more likely to have PhD ‘s on staff bc of New Media/Web design. Recently graduated PhD’s are able to develop strong ties, want to do something different.

Achieved: (examples) more space allocation to users, less to materials. More diverse skill set. Increase in foot traffic. New media center. Robotic scan machine (gift) for digitization of unique collection.

As far as I can tell, he was not (or didn’t mean to be) offensive. He never said that PhD’s or IT-people were any better than MLS-librarians. He never said that he would replace librarians by academic people. He only aimed to “add new blood”, enthusiastic new graduates “fit” for new specialist tasks to add to his staff. Nothing wrong with that. How his management affects his staff and his library in reality, I can’t tell.

As a PhD librarian, do I agree with Jeff? Well only in so far that PhD- and IT- and perhaps a bunch of other people could be a very welcome addition to the library. It is not always necessary to add them to your staff. Sometimes cooperation with an other department will do. I love to work with a freshly graduated problem-solving (medical) IT person full of new ideas, who can fulfill dreams I can’t realize because I miss the skills.

I also think that PhD’s might have some special skills and qualities that may be an advantage for some tasks. But so have “traditional” librarians.

Indeed, Our Dutch Academic Libraries are also hiring more researchers and/or PhD’s with or without a special post-doc library education. Our medical library now has two former scientists, and it is not excluded that more might be hired in the future.

What surprised me the most in Jeff’s talk was that he was so outspoken, without good arguments. It also surprised me that his approach seemed to be applied to each and every faculty library.
Our libraries are all very different. At one faculty books and cataloging are very important, in another electronic databases, yet another’s main task is heritage digitization (they would love the robotic scan machine). Some libraries have mainly students as clients, other scientist, others clinicians, yet others a mix of those.

I cannot imagine that engaging students with gaming suites and playing around a little with web 2.0 tools should be the ultimate goal of all libraries. I don’t agree that the library should be like a museum, a conference center or a lab, like Jeff proposes.

As a matter of fact, at our hospital are already abandoning the idea that all teaching material for medical students should be *fun*, in the form of games. Students don’t want to game, unless it is functional. They want to pass their exams in the first place, and become doctors in the second.

Our medical library goes through many phases the McMaster university has gone through. Our emphasis is on facilitating access to relevant information, on education and on searching. We have noticed a shift towards more complex, extensive searches for systematic reviews and guidelines. Thus, our librarians are now becoming the “added value”, not the techniques. We think we meet the needs of our customers the best that way.

I wonder whether the medical library of McMasters, famous for its critical appraisals and search filters (PubMed clinical queries) would now concentrate on gaming or museum function only. As a matter of fact, it is hard to imagine.

Thus I mainly disagree with Jeff in that he just picks a direction and goes for it (and think PhD’s do the job wherever he goes). He might enter a road with one end blocked off . PhD’s wont save you once you go wrong….

I did not attend TEDx Maastricht (you have to be invited)*, but I followed it with one eye on Twitter.

TEDx is a program of local, self-organized events that bring people together to share a TED-like experience: ideas worth spreading. This special TEDx event was held April 4th in the beautiful city Maastricht an had as central theme: The Future of Health.
TEDx Maastricht was an initiative of Lucien Engelen, Director of the Radboud REshape & Innovation Centre. I have attended the Zorg2.0-event Lucien organized in Nijmegen in 2009 and I can imagine the inspiring atmosphere of this larger scale TED-meeting.

Links to videos, photo’s, interviews, a mindmap, social mentions and more can be found at a Netvibes page, compiled by the Dutch (Tech) Librarian Guus van den Brekel.

Another Medical Librarian, Bianca Kramer, gave a summary of all talks with links to the videos at the Dutch “Medisch team UBU” blog: see part 1 and 2. Especially recommended for Dutch people.

Here are a few talks I selected, mainly chosen because of what others said online.

In the TEDx, like the Zorg2.0 meeting, the patient is central. Thus lets start with the patients.

I was very much impressed by the talk of Sophie van der Stap – “Girl with the nine wigs”. Apart that she “performs” very well, she has a moving and heartwarming story. At the age of 21 years she was diagnosed with a rare form of cancer. When she became bold, because of the chemotherapy, her wigs provided a “medicine”, because it made her feel happy and strong again.

“I know that in the Medical world the focus is on the pills, the tests and the surgery site of cancer. However I do hope that my story inspires you to share it with your patients to find their own cancer holiday”

Perhaps the most well known e-patient is David deBronkart, better known as “e-patient Dave”. He shares what he went trough as an almost dead patient, and how he found out what e-patient (really) means. His motto: Patient is not a third person word & The patient is the most underutilized resource in health care. January 2007, Dave was diagnosed with kidney cancer at a very late stage. His doctor “prescribed” a patient community site: ACOR.org :

“They very quickly told me Kidney Cancer is a not common disease, get yourself to a specialist center, there is no cure, but there is something that sometimes works, that usually doesn’t, called high dose interleukin. Most hospitals don’t offer it, so they won’t even tell you it exists. And don’t let them give you anything else first and by the way here are 4 doctors in your part of the US that offer it and here are their phone numbers…..”

There is no (other) website that gives you this info: Patients know what patients want to know!

Here is the complete video with more examples what e-patients stand for and don’t miss his rap act: Give me the data! (It is my live to save)

An other noteworthy video comes from Salmaan Sama, a medical student from Amsterdam, who lost his passion and drive in his study (it was all about medicine, physiology etc), but who regained it: At TEDx he presents a new initiative: c♥m-passionfor care based on the TD-price winning initiative of Karen Armstrong.

The first statement of the charter:

We believe everyone has the capacity to be compassionate: to treat others as you would wish to be treated. To be kind and tender, generous and forgiving, hospitable, helpful and attentive, curious, listening and present, empathic and connected, respectful, understanding and acknowledging. It takes courage, self-reflection and self-compassion.

Another Dutch physician (neurosurgeon) Pieter Kubben talked about a subject close to my heart: EBM tailored to the patient (i.e. see my posts, refs 7- 10). What does a patient expect when he visits a doctor (besides compassion): the best available treatment! “Best”, according to the EBM-evangelist Sackett, is scientific evidence combined with physician experience and patient preference.
PubMed is the most used information source for biomedical information. This information is increasing to what the WHO calls: “no do gap”. Unlike what people think (especially policy makers) EBM is not restricted to class I evidence (RCT’s and meta-analyses): class II and III evidence count as well. RCT’s may show which treatment may be “better”, but it is not tailored to the patient. Pieter thinks decision supportive systems, which tailor the information to the physician and the patient, might offer a solution.
In an article in the main Dutch medical journal, the NTVG, Piet Kubben explains that such a support system is unlike cookbook medicine. Freely translated:

What is the problem? If I make lasagna and follow a recipe, there a good chance that the result will be edible. I can leave ingredients, or add some, but when I do I have a reason for it. Decision support is no decision making. You can make another decision and sometimes you should..

Pieter has made 3 free apps for the I-phone: ‘NeuroMind’, ‘Safe Surgery’ en ‘SLIC’. NeuroMind, an app meant to support decision making in neurosurgery is listed in the widely cited “Top Apps” on iMedicalApps.com. We can thus assume that Pieter knows what he is talking about and that he can set realistic goals.

Health 2.0 talks often (over)emphasize the role of technology in health care. Wouter Bos, former Deputy Prime Minister and Minister of Finance provided the antidote for this belief in his “back to earth” speech: “We should cherish the technology, but it won’t change rising healthcare costs.” “In health care, if there is a new technique, medicine available, we WANT it”.Well it was a talk we can expect form an invited Party Pooper. But he made a good point.

Peer review is never funny, you think.
It is hard to review papers, especially when they are poorly written. From the author’s point of view, it is annoying and frustrating to see a paper rejected on basis of comments of peer reviewers, who either don’t understand the paper or thwart you in your attempts to get the paper published, for instance because you are a competitor in the field.

Still, from a (great) distance the peer review process can be funny… in some respects.

Read for instance a collection of memorable quotes from peer review critiques of the past year in Environmental Microbiology (EM does this each December). Here are some excerpts:

Done! Difficult task, I don’t wish to think about constipation and faecal flora during my holidays!

This paper is desperate. Please reject it completely and then block the author’s email ID so they can’t use the online system in future.

It is sad to see so much enthusiasm and effort go into analyzing a dataset that is just not big enough.

The abstract and results read much like a laundry list.

.. I would suggest that EM is setting up a fund that pays for the red wine reviewers may need to digest manuscripts like this one.

I have to admit that I would have liked to reject this paper because I found the tone in the Reply to the Reviewers so annoying.

I started to review this but could not get much past the abstract.

This paper is awfully written. There is no adequate objective and no reasonable conclusion. The literature is quoted at random and not in the context of argument…

Stating that the study is confirmative is not a good start for the Discussion.

I suppose that I should be happy that I don’t have to spend a lot of time reviewing this dreadful paper; however I am depressed that people are performing such bad science.

Preliminary and intriguing results that should be published elsewhere.

Reject – More holes than my grandad’s string vest!

The writing and data presentation are so bad that I had to leave work and go home early and then spend time to wonder what life is about.

Very much enjoyed reading this one, and do not have any significant comments. Wish I had thought of this one.

This is a long, but excellent report. […] It hurts me a little to have so little criticism of a manuscript.

MEDLINE is the National Library of Medicine‘s (NLM) premier bibliographic database of citations from biomedical journals. The content of MEDLINE is available via commercial, fee-for-service MEDLINE vendors, like OVID.

I may complain about PubMed once in a while and I may criticize some of its new features, but I cannot imagine a working life without PubMed. Probably this is even more true for biomedical scientist and physicians who have only access to freely available PubMed and not to OVID MEDLINE, EMBASE and Web of Science, like I do. PubMed and many other NLM databases have become an indispensable source of Medical Information.

We are so used to these free sources, that we take them for granted. Who would imagine that PubMed -or any other great free NLM/NIH database would cease to exists? Still, shutdown of these databases was imminent last weekend. Remarkably it largely went unnoticed, especially for people outside the U.S.

Did you know that there was a great chance of PubMed being killed this weekend?

I happened to get the news via my Twitter stream. I joined in around Friday midnight -Dutch time, 3-4 days ago.

This post isn’t meant to dive deep into the US political debate. It is just meant to reflect on the possibility that one of those federal databases, on which we rely, is wiped away overnight, thereby seriously affecting our usual workflows.

Some consequences when PubMed (and MEDLINE?) would disappear:

Many Doctors can no longer search efficiently for medical information (only brows medical journals, “Google” or look up outdated info).

The same is true for many scientists. Look at FlutesUD remarks about the references for her thesis.

The disappearance of Pubmed would especially affect rural areas and third world countries.

EBM would become difficult to practice:

The comprehensive search of PubMed, obligatory for systematic reviews, has to be skipped.

It would become almost impossible to do a critical appraised topic (i.e. interns are often used to search/have only access to PubMed)

CENTRAL (the largest database of controlled trials) can no longer retrieve its records from PubMed.

Librarians can delete many tutorials, e-learning materials and -even- classes.

Perhaps many librarians can even say goodbye to their jobs?

MYNCBI Saved searches and alerts are gone.

MYNCBI Saved papers (collections) are no more.

3rd party Pubmed tools (Novoseek, GoPubMed, HubMed) would also cease to exist.

Commercially available MEDLINE sources will be affected as well.

By the way clinical.trials.gov, TOXNET etc would also stop. Another hit for librarians, doctors and patients.

For many, disappearance of PubMed is a relative “minor” event compared to the shutdown of other services like the NASA, or healtcare institutions. The near-disappearance of PubMed made me realize how fragile this excellent service is on which we -librarians, physicians, medical students and scientists- rely. On the other hand, it also made me realize how thankful we should be that such a database is available to us for free (yes, even for people outside the US).

Note: (Per 2011-04-14)

I have changed the title from “PubMed’s Sudden Death averted” to “PubMed’s Shutdown averted”, because Death is permanent and it was unknown if the shutdown, if any, would be permanent.

I have also changed some words in the text (blue), thus changed disappearance to “shutdown” for the same reasons as mentioned above.

On the other hand I’ve added some tweets which clearly indicate that the shutdown was not “nothing to worry about”.

The tweets mentioned are not from official resources. And this is what this post is partly about. The panic that results if there is a lack of reliable information. Other main points: (2) the importance of PubMed for biomedical information and (3) that PubMed’s permanent (free) existence is not granted.

Only my youngest daughter (11) was fooled …. by her teacher. She has 2 teachers. Today (April 1st), one of them was to be replaced by another. When the class started, the main teacher came in and said: “Sorry guys, the new teacher couldn’t make it: she is ill” . Then she left … to come back with the new teacher. A lovely April Fools day joke. And a good way to introduce the new teacher.

Indeed many Google jokes were really good. Like the gmail-motion (a new motion technology that interprets physical movements to translate it).
And the development of a new Android app that translates your pets words into human language.
This was also covered by GrrlScientist at Punctuated Equilibrium (Guardian Science)

Not mentioned at Search Engine Land, is what happens if you Google “helvetica” ….
(It also worked with “comic sans” by the way)

In the Netherlands, there was an advertisement for new SENSEO® beer pods giving you a full, cold glass of Heineken beer (only to be used in combination with the Philips SENSEO® coffee pod system Hot ‘n Cold®). See http://www.bierpad.nl/ for the full advertisement.

Did you know, there is a web site that keeps track of the major April Fools’ Day Jokes that Web Sites have run each year (from 2004 till today): http://aprilfoolsdayontheweb.com/.
Besides the Google Jokes, there are several other good traps this year: A Blackberry with no screen, Pay what you weigh for your airline seat & All donations going to church of scientology (http://aprilfoolsdayontheweb.com/2011.html).

And just when you think it’s over and you save your last draft just before 00.00 am, you notice that WordPress puts in a word too.